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Objective: To investigate the efficacy of auto-cross-linked hyaluronic acid (ACP) gel in preventing adhesion recurrence after transcervical resection adhesion (TCRA) in patients with mild to moderate intrauterine adhesion (IUA) and its effect on reproductive outcomes. Methods: 188 patients with mild to moderate IUA who underwent TCRA in Fuxing Hospital of Capital Medical University from May 2020 to March 2021 were collected, and the recurrence rate of postoperative IUA, American Fertility Association (AFS) score, menstrual improvement and reproductive outcomes were observed in a single-center prospective randomized controlled manner, and the efficacy of ACP gel in preventing recurrence of IUA and its effect on reproductive outcomes were analyzed. The study group (84 cases) was received intrauterine injection of ACP gel + balloon stent at the end of surgery, and the control group (87 cases) only received balloon stent at the end of surgery. Results: 171 cases underwent the second and third hysteroscopies at 4 and 8 weeks after surgery, respectively. The recurrence rate of IUA in the study group was slightly lower than that in the control group, but the difference was not statistically significant (20.2% vs. 23.0%, 9.5% vs. 11.5%, both P＞0.05). There was no significant difference in AFS scores between the two groups (P＞0.05). There was no significant difference in menstrual improvement between the two groups at 12 weeks after surgery (P=0.630). More than one year after TCRA operation, there was no significant difference in pregnancy rate and live birth rate between the two groups (both P＞0.05). Conclusions: In patients with mild to moderate IUA, compared with balloon stent alone after TCRA, balloon stent combined with intrauterine injection of ACP gel did not reduce the recurrence rate and adhesion severity of IUA, nor could it promote the improvement of menstrual pattern and postoperative reproductive outcome. [ABSTRACT FROM AUTHOR]

With the onset of cancer at a younger age, more and more women of childbearing age are suffering from endometrial cancer. In order to preserve fertility, most patients tend to conservative treatment. Therefore, many researchers have proposed conservative treatment plans for atypical endometrial hyperplasia and early endometrial cancer, and have been clinically studied in small samples. Traditional therapy is mainly oral high-dose progesterone. However, most patients with oral progesterone treatment have high recurrence rate and many complications. Levonorgestrel-releasing intrauterine system can reduce the side effects to the body caused by a large amout of progesterone through local effects on the endometrium. Hysteroscopy can precisely remove the lesion, protect the normal endometrium, and relatively reduce the risk of infertility and miscarriage in the later pregnancy. The anti-tumor effect of metformin can increase the effective rate of progesterone. Now，we summarizing relieving rate, recurrence rate, and pregnancy outcomes of the atypical endometrial hyperplasia and early endometrial cancer after various conservative treatments, in order to evaluate the own factors and disease characteristics of each patient before clinical treatment to choose the most beneficial treatment plan and management model for patients. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.

Objective: Molecular features are essential for estimating the risk of recurrence and impacting overall survival in patients with endometrial cancer. Additionally, the surgical procedure itself could be personalized based on the molecular characteristics of the tumor. This study aims to assess the feasibility of obtaining reliable molecular classification status from biopsy specimens collected during hysteroscopy to better modulate the appropriate surgical treatment., Methods: This monocentric, retrospective, observational study was conducted on 106 patients who underwent a biopsy procedure followed by radical surgery for endometrial cancer, with concurrent molecular investigation. The molecular classification was determined through immunohistochemical staining for p53 and mismatch repair proteins, along with gene sequencing for POLE., Results: Overall, 106 patients underwent molecular investigation, which was finally achieved on 99 patients (93.4%). Among these, the molecular analysis was conducted in 71 patients (67%) on the pre-operative endometrial biopsy and on the final uterine specimen in 28 patients (26.4%). Most of the endometrial biopsies were performed using Bettocchi hysteroscopy (66%). Molecular analysis was not possible in seven patients (6.6%), with six cases due to sample inadequacy and one case attributed to intra-mucosal carcinoma. The molecular results showed that the copy number low sub-group was the most common, and five cases of 'multiple classifiers' were observed in the low-risk category., Conclusion: Our experience in obtaining molecular information from biopsy samples underscores the feasibility and efficacy of this technique, even in small tissue samples. This capability helps define the prognostic group of patients, facilitates timely decision-making, and develops a personalized strategy for each patient., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Hysteroscopy represents the gold standard for the diagnosis and treatment of intrauterine pathologies. The advent of the mini-resectoscope heralded a new era in intrauterine surgery, both in inpatient and outpatient settings., Objectives: To evaluate the effectiveness, safety, and feasibility of the mini-resectoscope for the treatment of intrauterine pathologies., Search Strategy: Electronic databases were searched for English-language trials describing surgical procedures for uterine pathologies performed with a mini-resectoscope until 30 April 2023., Selection Criteria: Retrospective or prospective original studies reporting the treatment of uterine pathologies with mini-resectoscope were deemed eligible for the inclusion., Data Collection and Analysis: Data about study features, characteristics of included populations, surgical procedures, complications, and results/outcomes were collected., Results: Seven papers that met the inclusion criteria were included in this systematic review. Quantitative analysis was not possible due to data heterogeneity. A descriptive synthesis of the results was provided accordingly to the pathology hysteroscopically removed/corrected: polyps and myomas, uterine septum, intrauterine synechiae, and isthmocele., Conclusions: The mini-resectoscope is poised to play a leading role in hysteroscopic surgery for many pathologies, both in inpatient and outpatient settings. Since some applications of the mini-resectoscope have not yet been thoroughly investigated, future studies should address current knowledge gaps, designing high-quality comparative trials on specific applications., (© 2024 International Federation of Gynecology and Obstetrics.)

Adenomyosis is a high incidence of disease which seriously endangers women′s health. It is difficult to diagnosis in the early stage. Hysteroscopy can be used to identify specific or nonspecific lesions in the uterine cavity of patients with adenomyosis, sometimes being subtle and characteristic lesions. These lesion include endometrial invagination, vascular hyperplasia, endometritis, uterine compression and cystic adenomyosis. Therefore, hysteroscopy plays an important role in the diagnosis of adenomyosis. Hysteroscopy combined with ultrasound can improve the diagnostic rate of hysteroscopy for adenomyosis, and help to determine the size, location and depth of lesions. Under the guidance of ultrasound, hysteroscopic biopsy can obtain the tissue of the endometrial -myometrial interface for histopathology, which is the most valuable minimally invasive diagnostic method for adenomyosis. This method provides the possibility of individualized treatment for those adenomyosis patients with fertility requirements or desire to preserve the uterus. [ABSTRACT FROM AUTHOR]

Congenital uterine abnormality is the most common abnormality in the female reproductive system, which easily leads to adverse pregnancy and obstetric outcomes, and has a serious impact on women′s physiology and psychology. In recent years, the application of minimally invasive surgery such as hysteroscopy and laparoscopy in the correction of uterine anomalies such as septate uterus, bicornuate uterus, unicornuate uterus and rudimentary horn uterus, T-shaped uterus, and Müllerian duct dysplasia is more and more widely, gradually replacing the traditional surgery, and become the main method for the treatment of uterine anomalies. Hysteroscopic septum resection, bicorporeal uterus hysteroplasty, laparoscopic rudimentary horn excision, hysteroscopic T-shaped hysteroplasty and even uterine transplantation are carried out to protect the reproductive function, improve the pregnancy rate and the adverse pregnancy outcome of patients with congenital uterine abnormalities. This paper reviews the latest research progress on the impact of minimally invasive corrective surgery for congenital uterine anomalies on the reproductive outcomes of female patients, and discusses whether corrective surgery for uterine anomalies can improve the fertility and pregnancy outcomes of patients with uterine abnormalities. [ABSTRACT FROM AUTHOR]

With the postponement of the childbearing age of women worldwide, the preservation of fertility in young endometrial cancer patients has received more and more attention. Most early-stage young endometrial cancers are mostly estrogen-dependent, with limited lesions, slow progress, good differentiation and prognosis, and good response to sex hormone therapy. High-efficiency, high-dose, long-term use of progesterone is the key to the success of the treatment. The safe and effective comprehensive assessment is particularly important. This article takes the typical cases of successful treatment as a guide to elaborate on the latest developments in this field. [ABSTRACT FROM AUTHOR]

Objective: To investigate the pregnancy outcomes and its related influencing factors of moderate and severe intrauterine adhesions after transcervical resection of intrauterine adhesions (TCRA). Methods: One hundred and forty-five patients with moderate-to-severe IUA (IUA score ≥5) with fertility dysfunction who were diagnosed at the Beijing Obstetrics and Gynecology Hospital of Capital Medical University from January 2014 to December 2016 were selected. The pregnancy outcome after TCRA was followed-up and the factors that may affect pregnancy were analyzed. Results: ①Among 145 patients with moderate to severe IUA, the pregnancy rate after TCRA was 46.9% (68/145), the natural conception rate was 54.4% (37/68), and artificial assisted conception rate was 45.6% (31/68); The pregnancy rate of secondary infertility was 45.8% (33/72), that of the adverse pregnancy history and the primary infertility was 48.3% (28/58), 46.7% (7/15) respectively. The postoperative pregnancy rate in patients with moderate IUA and severe IUA were 64.9% (48/74) and 28.2% (20/71), respectively. The pregnancy rate of patients with pregnancy-related curettage ≥ 3 times was 36.6%(34/93), while the others was 65.4% (34/52). The pregnancy rates of patients with normal menstruation, menstruation reduction and amenorrhea preoperatively were 73.1% (19/26), 48.8% (40/82) and 24.3% (9/37), respectively. The pregnancy rate of of patients with normal menstruation, menstruation reduction postoperatively was 54.6% (59/108) and 28.6% (8/28) respectively. Among 28 patients with re-adhesion, only two patients with mild adhesions were pregnant (7.1%, 2/28). 41.2% (28/68) of pregnancies had abortion or spontaneous abortion before 12 weeks of gestation and 58.8% (40/68) were reached to live births, with the mean gestational age of 38±1 weeks (32 to 41 weeks), and mean body weight of 3 467± 461 g (1 800 to 4 400 g). For obstetric complications, there were 2 cases of placenta previa, 6 cases of postpartum hemorrhage, and 2 cases of blood transfusion. No uterine rupture occurred. ②Multivariate logistic regression was performed by stepwise regression.Only pregnancyrelated curettage, preoperative adhesion, and postoperative re-adhesion were found to be independent predictors of postoperative pregnancy outcomes (P＜0.05). Conclusions: Even after TCRA surgery to restore uterine cavity morphology, the pregnancy rate of moderate to severe IUA is still low, especially the patients with recurrence of IUA. So pay attention to the protection of residual endometrium during surgery, and take effective measures to promote endometrium regeneration and prevention of re-adhesion after surgery are the key to treatment. [ABSTRACT FROM AUTHOR]

A case of cornual pregnancy misdiagnosed as incomplete abortion in another hospital was analyzed retrospectively, and the literatures of cornual pregnancy were reviewed. The etiology of cornual pregnancy may be related to pelvic inflammatory disease, abnormal reproductive organs and other factors. However, it is still not clear. Early diagnosis of cornual pregnancy is difficult, and misdiagnosis and missed diagnosis are common. The cornual pregnancy should be alerted when there are incomplete abortion, expired abortion, induced abortion incomplete, dilation and curettage incomple. The ultrasound examination in early pregnancy can improve the accuracy of diagnosis. Compared with expectant therapy, drug conservative treatment and ultrasound -guided induced abortion, the minimally invasive surgery has a higher success rate and lower risk. It is understandably less invasive than laparotomy. Therefore, the minimally invasive surgery should be advised in the diagnosis and treatment of cornual pregnancy. [ABSTRACT FROM AUTHOR]

Intrauterine device (IUD) is currently the most widely used contraceptive tool in China. IUD is easy to break, incarcerate and ectopic when placed for a long time. Once IUD is found to be broken, incarcerated, and ectopic, diagnosis should be made. A safe, reliable, and minimally invasive surgical procedure should be chosen to improve the success rate of removing the IUD and to avoid serious complications. Due to direct vision and minimally invasive, hysteroscopy provides a new method for removing the IUD. For elderly women with menopausal time of more than 2 years and IUD partial deformation, fracture and residual, the difficulty of removing the IUD is large and the complications are many. Patients can be hospitalized and underwent hysteroscopic under ultrasound to reduce the incidence of complications and improve the success rate of removing the IUD. Peking University Shenzhen Hospital admitted a 72-year-old female patient on March 11, 2019. The patient was admitted to the hospital with intrauterine device rupture. After admission, hysteroscopic was performed under ultrasound to remove the IUD successfully. This article reviews the relevant literature for the case report. [ABSTRACT FROM AUTHOR]

Endometrial carcinoma is a common invasive malignant neoplasm, and conservative management of endometrioid endometrial carcinoma may be a therapeutic option for young nulliparae. Conventional drugs for conservative treatment include progestin, gonadotropin releasing hormone analogue, aromatase inhibitors. Hysteroscopy combined progestogen therapy is a novel therapeutic treatment for young women with early stage well -differentiated endometrioid endometrial cancer, and gains advantages in regression, pregnancy, relapse and adverse effect over treatment using drugs alone. There is no consensus, however, regarding the surgical procedures and ideal progestin agent, dose, or duration of treatment. Morbidly obese patients should accept obesity therapy to decrease the risk of recurrence, among which bariatric surgery has a better effect. Bariatric surgery is an effective intervention for young patients with early stage well-differentiated endometrioid endometrial cancer whose BMI is over 35 kg/m2. Bariatric surgery should be considered for patients who are inadequately controlled by non-surgical treatment with BMI≥35 kg/m2 or metabolic syndrome/T2DM (BMI≥30 kg/m2). [ABSTRACT FROM AUTHOR]

Objective：To compare the efficiency and safety of two methods taking out the incarcerated intrauterine device (IUD): hysteroscopy and B -mode ultrasound. Methods: A total of 87 patients underwent unsuccessfully the conventional removal of IUD were diagnosed as the incarcerated IUD from January 2013 to March 2017. Based on a random table, the 45 cases were treated with hysteroscopy to take out their IUD as the observation group, and 42 cases with B-mode ultrasound to take out IUD as the control group. The operation time, intraoperative blood loss, the success rate of taking out IUD at once, hospital stays and expense were compared between the two groups. The incidences of lumbar pain and low-abdominal pain and vaginal bleeding in 1 month of following up were also compared. Results: The success rate of IUD removal at once in the observation group was significantly higher than that in the control group ( χ2=7.112, P=0.000). The operation time and the bleeding amount in the observation group were significantly less than those in the control group ( χ2=4.322 and 6.083, all P＜0.05). There were no complications such as uterine perforation, intrauterine adhesions and infection in one month of following up in the two groups. The incidences of 0~Ⅰ grade of lumbar pain and low-abdominal pain, and ≤1 day of vaginal bleeding or no bleeding, in observation group were significantly higher than those in the control group (all P＜0.05). There was no significant difference in hospital stays between the two groups [(2.24± 0.63) d vs. (2.08±0.54) d, t=0.003, P=0.976]. However, the treatment cost in the observation group was significantly higher than that in the control group [(2 231.28±256.90) Yuan vs. (1 712.14±156.82) Yuan, t=6.117, P=0.007]. Conclusions: Taking out the incarcerated IUD under hysteroscopy can be recommended due to the shorter operation time, less blood loss, higher success rate and higher safety, although the relatively higher treatment cost, when compared with the method under B ultrasound. [ABSTRACT FROM AUTHOR]

Objective：To explore the improvement of reproductive outcome in those women with a complete bicornuate uterus who underwent metroplasty by the laparoscopy combined with hysteroscopy. Methods: 19 women with complete bicornuate uteri who underwent metroplasty by the laparoscopy combined with hysteroscopy in our hospital from October 2006 to November 2015 were retrospectively analyzed. The pregnancy outcome was followed-up. Results: 19 women were followed up for 2 to 11 years, and 4 of them dropped. In 15 women, 9 cases of pregnancy and 6 cases of non -pregnancy were recorded after their one -year effective postoperative contraception. The first postoperative pregnancy time after metroplasty ranges from 14 to 46 months. For the 9 women who had conception, the rates of spontaneous abortion (90.5% vs. 10.0%), term delivery (0 vs. 50.0%) and "take-home-baby" (0 vs. 80.0%) were recorded before and after the operation (all P＜0.05). Of the 19 patients, a total of 4 patients with complete bicornuate uteri combined with cervical insufficiency underwent laparoscopic abdominal cerclage before pregnancy, and 2 of them achieved successful pregnancy and delivered live babies. Conclusions: The metroplasty by the laparoscopy combined with hysteroscopy can significantly improve the reproductive prognosis for those women with adverse pregnancy outcomes owing to complete bicornuate uterus. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate whether retaining myoma pseudocapsule has effect on the healing of uterine wound of hysteroscopic myomectomy for symptomatic type 2 uterine myoma (according to classification for myoma of FIGO, 2011). Methods：From January 2014 to September 2017 in Fuxing hospital, cases of type 2 uterine myoma (single, larger than 2.5 cm) were collected for heaving uterine bleeding and were performed one -step hysteroscopic myomectomy. A total of 70 cases were divided into 2 groups, the myoma pseudocapsule were retained after myomectomy for Group A (35 cases), the myoma pseudocapsule protruding into the uterine cavity were removed for Group B (35 cases). The following medical data were recorded: the age of patients, the size of the myoma, pre-operative treatment by GnRH analogue, operation time, blood loss during the operation, surgical complications. At 1 and 3 months after the operation, second -look hysteroscopy was performed to observe and compare the uterine cavity wounds healing condition of the two groups. Results： There is no significant difference of patients′ age, size of the myoma and the use of pre -operative GnRHa between the two groups; the mean operation time of group A was (33.3±12.3) min (range 17～65 min), the operation time of group B was (32.7± 12.1) min (range 18～70 min), there was no significant difference (t=0.195，P=0.846). The mean volume of intra-operative blood loss of group A was (26.4}16.3) mL (10～50 mL), the mean volume of intra-operative blood loss of group B was (26.7}15.8) mL (10～50 mL), there was no statistical difference (t=－0.074，P=0.941); the incidence of intrauterine adhesions after 1 months was 5.71% (2/35) in group A and 20.00% (7/35) in group B, there was no significant difference ( χ2=3.188，P=0.074); the incidence of intrauterine adhesions after 3 months was 0 (0/35) in group A and 11.43% (4/35) in group B, there was significant difference (P =0.039). Conclusions：Myoma pseudocapsule should be protected and retained for hysteroscopic myomectomy surgery. Second-look hysteroscopy is important for prevention intrauterine adhesion after hysteroscopic myomectomy. [ABSTRACT FROM AUTHOR]

Objective：To analyze the efficacy and the reproductive outcome of hysteroscopic adhesiolysis. Methods：A total of 40 patients diagnosed with intrauterine adhesion received hysteroscopic adhesiolysis in The Sixth Affiliated Hospital of Sun Yat-Sen University from January 2014 to December 2016. The thickness of the endometrium and the reproductive outcome were observed. Results：Among the 40 patients (25 with moderate IUA, and 15 with severe IUA) who underwent hysteroscopic adhesiolysis, 19 cases use the bipolar electrode knife cutting adhesion, while 21 cases using micro-scissors. The reproductive outcome of 40 women underwent 64 assisted reproductive technology cycles were observed. The mean endometrial thickness and thin endometrium rate of the bipolar electrode knife group were 7.0 (6.0~9.3) mm and 46.9%, while 8.0 (7.0~9.8) mm and 31.3% in the micro-scissors group, no statistical significance was found between the two groups (P＞0.05). The implantation rate, conception rate, live birth rate, miscarriage rate and ongoing rate after hysteroscopic adhesiolysis in the bipolar electrode knife group were 46.9%, 37.5%, 18.8%, 6.3% and 12.5%, respectively, while in the micro-scissors group were 34.4%, 28.1%, 12.5%, 3.1% and 12.5%, respectively (P＞0.05). The average conception time of bipolar electrode knife group was 7.5 (4.0~12.0) months longer than the micro-scissors group 3.0 (3.0~8.5) months, the difference reached statistical significance (P＜0.05). Conclusions：Hysteroscopic adhesiolysis is an effective and safe option for IUA patients that can improve the reproductive outcome, different methods of operation does not affect the reproductive outcome. [ABSTRACT FROM AUTHOR]

Previous cesarean scar defect (PCSD) is one of the long-term complications after cesarean section, which can cause clinical manifestations of menstruation, infertility, cesarean scar pregnancy etc. The incidence rate of PCSD is increasing. The commonly used auxiliary examinations are transvaginal ultrasound and saline infusion sonohysterography. Minimally invasive surgerys are the main treatments, including hysteroscopy, laparoscopy and transvaginal surgery. Hysteroscopy is the most invasive surgery, it can remove the fibrotic scar tissue to facilitate menstrual blood drainage and perform fulguration of endometrial-like glands inside the scar to reduce irregular bleeding, it can also improve the endometrial environment conducive to pregnancy, but because of electrical injury and uterine perforation risk, it is suitable for patients whose residual muscle layer thickness is more than 2 mm, the postoperative pregnant women need to be treated as the high risk population of uterine rupture. As for the patients whose residual muscle layer thickness is less than 2 mm, laparoscopic surgery or vaginal surgery should be adopted to remove the scar diverticulum and suture it again, which can improve the symptoms effectively. [ABSTRACT FROM AUTHOR]

Uterine malfomation is common female reproductive system dysplasia, containing a variety of types. Though there are several classification systems in clinical practice, the standard of classification is not unified. Accurate classification is important for assessing patient and making treatment plan. Ultrasonography and MRI have been widely used to diagnose and classify uterine malformation. Different types of uterine malformation can bring different degree of effects on female fertility and pregnant outcome. With the development of minimally invasive technologies, hysteroscopy combined with or without laparoscopic uterine malformation metroplasty has gradually replaced traditional laparotomy surgery. However, there is still no certain conclusion on whether or not uterine malformation metroplasty could improve female reproductive prognosis and the pregnant outcomes. [ABSTRACT FROM AUTHOR]

Uterine septum is the most commonly encountered congenital müllerian anomaly． It leads to infertility, recurent abortion，preterm delivery and premature rupture of membrane，and then affects pregnancy outcome． Surgical correction is required for uterine septum． Transcervical resection of septum (TCRS) is the gold standard for the treatment of uterine septum and the masterpiece of the success of hysteroscopic surgery．Hysteroscopic surgery is minimally invasive，safe and effective methods，which can improve pregnancy outcome significantly． Common complications of hysteroscopy are uterine perforation，fluid overload，bleeding，residual septum，intrauterine adhesions and pregnant uterine rupture secondary to the surgery． This article is intended to explore its causes and prevention. Although complications are rare in the short and long term，they cannot be ignored in clinical practice in order to improve the safety of surgery and further reflect the preponderance of minimally invasive hysteroscopic surgery. [ABSTRACT FROM AUTHOR]

Chronic endometritis was often overlooked because of its nonspecific symptoms. However, it has drawn more and more attention recently because of its influence on female reproductive prognosis, and abnormal uterine bleeding. Clinical features of chronic endometritis under hysteroscopy were as follows: ①focal or diffuse periglandular hyperemia; ②endometrial stromal edema, increased thickness of the endometrium, with whitish color and irregular surface, and out of phase; ③pedunculated micropolyps (less that 1 mm), stromal edema, or micropolyps with focal or diffuse periglandular hyperemia. The accuracy of hysteroscopic diagnosis of chronic endometritis is affected by the media and doctor′s experience. There is a great difference between the hysteroscopic diagnosis and the pathological diagnosis. The value of hysteroscopy in the evaluation of chronic endometritis has been recognized, but it is still controversial whether hysteroscopy can be used as an independent diagnostic criteria for chronic endometritis. The histopathological diagnosis should be advised if chronic endometritis is clinically suspected under hysteroscopy, so as to reduce the influence of the persistent chronic endometritis on female reproductive prognosis. [ABSTRACT FROM AUTHOR]

Endometrial polyp is a common gynecological disease, which is a cause of abnormal uterine bleeding and infertility. Endometrial polyps may be related to enviromental estrogen exposure or chronic inflammatory response. Morbidity of endometrial polyps increased in infertility women. Three-dimensional ultrasound, SIS, hysterosalpingograms (HSG) and hysteroscopy are main diagnostic methods. SIS and hysteroscopy are two effective and reliable methods with higher sensitivity and specificity. Endometrial polyps less than 10 mm in diameter may undergo spontaneous regression. Blind dilation and curettage (D&C) is not recommended. Hysteroscopic polypectomy, as main treatment of conservative surgery with low complications, can improve reproductive outcome of infertility women. It is necessary to have more high-quality randomized controlled trials (RCT) to answer whether the hysteroscopic removal can be used as a conventional therapy in those infertile women with endometrial polyps. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical outcomes of endometrial reepithelialization between hysteroscopic scissors and resectoscope in those patients underwent transcervical resection of septum (TCRS). Methods: This is a randomized controlled study including 60 women with partial septate uterus, in our center from January 2015 to December 2016. Thirty cases underwent hysteroscopic metroplasty using hysteroscopic scissors (group A) and 30 cases had the procedure using the bipolar electrodes (group B). Main characteristics of the patients and operative parameters (operative time, blood loss, complications) were recorded. The hysteroscopic examination was performed after 1 and 2 months of surgery to evaluate the endometrial healing process including endometrial reepithelialization, intrauterine adhesions and residual suptum. Results: Although the operating time in the group A was significantly faster than that in the group B [(13.90±3.95) min vs. (23.13±5.15) min，P=0.00], there was no significant difference in the blood loss between the 2 groups [(8.67±2.25) mL vs. (8.83±2.15) mL，P=0.77]. There were not any intraoperative complications in two groups, and intrauterine adhesion or residual septum in two months follow-up visit. The poor reepithelialization in the group A was less than that in the group B [16.67% (5/30) vs. 93.33% (28/30), P=0.00], in the 1 month′s visit. However, the endometrium reepithelialization was completely satisfied in two groups after surgery. Conclusions: The endometrial reepithelialization is faster in the scissors group than that in the resectoscope group in the first month after surgery. However, the epithelialization status can be well satisfied in two groups within 2 months. [ABSTRACT FROM AUTHOR]

Objective：To evaluate the application of hysteroscopic tubal occlusion in those patients with hydrosalpinx before in vitro fertilization and embryo transfer (IVF-ET). Methods：One hundred and seventy two cases of hydrosalpinx were retrospectively analyzed in our hospital from 2015 to 2016. A total of 100 cases were performed hysteroscopic tubal occlusion (the group A) before IVF-ET, with 67 cycles of fresh embryo transfer and 76 cycles of blastocyst embryo transfer. Seventy two cases were performed laparoscopic proximate tubal ligation (as the group B) before IVF-ET, with 72 cycles of fresh embryo transfer and 64 cycles of blstocyst embryo transfer. The operation time, fertilization rate, high quality embryo rate, clinical pregnancy rate and abortion rate were analyzed. Results：The operation time in the group A was less than that in the group B [(21.18±7.89) min vs (44.56±20.30) min, P＜0.001]. There were no significant differences in the fertilization rate, high quality embryo rate, clinical pregnancy rate，abortion rate and miscarriage rate between the two groups (P＞0.05). Conclusions：The pregnancy outcome in those patients with hydrosalpinx who underwent the hysteroscopic tubal occlusion before IVF-ET was same as that in those laparoscopic proximate tubal ligation. Hysteroscopic tubal occlusion is a simple surgery with the advantages of minimal invasive, short operation time, no need of general anesthesia. and outpatient operation. [ABSTRACT FROM AUTHOR]

Objective：To study the clinical features, diagnosis, treatment and prognosis of patients with atypical polypoid adenomyoma (APA). Methods：This is a retrospective study of 24 cases who suffered from APA admitted in Fuxing Hospital, Capital Medical University from January 2006 to June 2015. Their clinical features, diagnosis, treatment and prognosis were analyzed. The clinical feature of 17 cases (70.8%) were vaginal bleeding, 1 case (4.2%) vaginal discharge, 3 cases (12.5%) primary infertility. Ultrasound had shown occupied lesions within uterine cavity in 3 patients (12.5%). Twenty two patients were performed hysteroscopic surgery. Diagnosis was confirmed by pathological report. Results：Diagnosis of 24 cases were confirmed by pathologic report. The diagnosis of polyp by hysteroscopy and color ultrasound were 61.1% and 68.4% separately. The diagnosis of submucous myoma by hysteroscopy and color ultrasound were 11.5% and 15.8% separately. The differences were no significantly. The operating time was (23.7±8.6) min (5-40 min), the operating bleeding was (6.5±2.9) mL (5-20 mL). Postoperative follow-up consisted 1 to 10 years for 24 cases. Four cases lose follow-up. Three patients were performed hysterectomy after hysteroscopic polypectomy and postoperative follow-up was normal. At 3 months later hysteroscopic second look still shown APA in 1 case who was performed hysteroscopic polypectomy again and intramuscular injection GnRHa, till pathological report was normal levonorgestrel-releasing intrauterine system(LNG-IUS) was inserted into uterine cavity. Up to now 2 years follow-up there was no abnormalities. One case was performed hysterectomy 8 years later because of endometrial intraepithelial neoplasia. Fifteen cases follow-up so far no abnormality. There were 2 infertile patients got pregnancy and term delivery after surgery. Conclusions：As an effective treatment of APA hysteroscopic surgery has many advantages: positioning accuracy, mini-invasive and low recurrence rate. Owing to APA had the possibility of recurrence and malignant change, after surgery continuously and closely follow-up is still important. [ABSTRACT FROM AUTHOR]

Objective: To identify the clinical features， relevant risk factors, differential diagnosis and treatment of the intramural pregnancy. Methods：Retrospective analysis of the surgery history, clinical features, auxiliary examination, diagnosis, treatment process and pathologic results on 4 patients admitted to our hospital with intramural pregnancy in 5 years. To understand the risk factors, differential diagnosis and treatment of the intramural pregnancy. Results：Four patients all belonged to the mass type of the intramural pregnancy. B-mode MRI diagnoses pregnancy in uterine horn and gestational trophoblastic neoplasia. All of the four patients accept hysteroscopy combined with laparoscopy surgery and supervise hCG concentration dropping to the normal level. Conclusions：In the clinical medicine, doctor should pay attention to the patient of incomplete abortion with hCG not dropping to the normal level or increasing, vaginal bleeding and B-mode ultrasound and MRI showing mesometrium mass. [ABSTRACT FROM AUTHOR]

Gestational trophoblastic neoplasia (GTN) usually occurs in women of reproductive age. GTN is sensitive to chemotherapy with a high cure rate of 90%-100%. The early diagnosis and standardized chemotherapy is important for the prognosis. The diagnosis of GTN mainly rely on clinical history, pelvic examination, measure of serum hCG level and imaging examination. However, it is essential to make differential diagnosis with other pregnancy-associated diseases, such as residual of placenta and ectopic pregnancy. To avoid the misdiagnosis and over-treatment, hysteroscopy and laparoscopy play an important role in the differential diagnosis of GTN. They can visually figure out the location, size and character of lesions, or take pathological evidence for under direct vision. They also can effectively salvage some patients with chemoresistant GTN, by resecting the GTN lesion located in the uterus and reducing the total courses of chemotherapy. Endoscopic technique is an effective alternative of diagnosis and treatment for GTN. [ABSTRACT FROM AUTHOR]

This experiment was carried out to investigate the effect of combined treatment of tubal obstruction infertility with deacetylated chitosan and two microscopes on the levels of IFN-γ and ICAM-1. In this study, 100 infertile patients with fallopian tube obstruction who were treated in Jiangbei District Hospital of traditional Chinese medicine from January to August 2019 were divided into two groups according to the alternating grouping method, group A (50 cases) received combined surgery, and Group B (50 cases) received combined surgery and chitosan. The curative effect and postoperative pelvic adhesion of the two groups were analyzed, and the levels of IFN-γ, ICAM-1 and IL6(IL-6), laminin (LN), Transforming growth factor beta 1(TGF-β1) and fibronectin (FN) were observed before and after treatment. Results showed that the total effective rate of Group B was higher than that of Group A (92. 00% vs 76. 00%). The incidence of pelvic adhesion was lower in Group A (4. 00% vs 16. 00%) (P < 0.05). The levels of IFN-γ, ICAM-1, IL-6, LN, FN and TGF-β1 in Group B were significantly lower than those in group A (P < 0.05). In conclusion, the treatment of tubal obstruction infertility with combined deacetylated chitosan and biendoscopy is effective, which can reduce the levels of IFN-γ and ICAM-1, improve the expression of adhesion-related factors and reduce the occurrence of pelvic adhesion.

Background: The hysteroscopic surgery has become a simple and safe technique, with the use of small hysteroscopes and bipolar energy with trained surgeons, which can prevent abortions and probably increase fertility. Aim: The study was conducted to evaluate the outcomes after hysteroscopic surgery by using uninopolar or bipolar electrodes. Setting and Design: At the department of Obstetrics and Gynaecology, Qena university hospital and is a prospective non randomized clinical study. Materials and Methods: One hundred fifty patients who included in this study were non randomly classified into two groups; one for hysteroscopic surgery by using bipolar electrode and the second group using unipolar electrode. Operative complications; bleeding, perforation, fluid over load and hyponatraemia were recorded. Also, operative time and hospital stay were included. Results: There were no statistically significant differences between both groups in patient’s characteristics, ultrasonographic findings, serum sodium levels before surgical interference, perforation and intraoperative bleeding. The fluid overload was significantly higher in unipolar group (p value= 0.03), postoperative hyponatraemia was significantly marked in unipolar group (p

Objective: To evaluate the clinical effect in patients with complete septum uterus, duplicated cervix and vaginal septum after hysteroscopic electroresection combined with laparoscopy. Methods:We retrospectively analyzed the clinical data of 27 patients with complete septum uterus, duplicated cervix and vaginal septum undergoing hysteroscopic resection combined with laparoscopy from 2012 to 2013 in Gynecological Minimal Invasive Center in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University. There are primary infertility 7, nature abortion 10, missed abortion 4, abnormal childbearing history 7. Results: The success rate of surgery was 100% without intra - or post-operative complications. The duration of post-operative follow-up ranged from 30 to 53 months, with an average of (41.56±6.33) months. There are full-term delivery 18 cases, premature delivery 1, nature abortion 2, inferlity 3, induced labor due to fetal anomaly 1, lost 1, have no birth plan 3. The pregnancy rate of patients with complete uterine septum increased from 52.17% (11/23, pre - operation) to 86.96% (20/23, post-operation, χ 2 =6.33, P=0.01). The full-term live birth rates increased from 0 (0/23, preoperation) to 82.61% (19/23, post-operation, P=0.000). The spontaneous abortion rates decreased from 47.83% (11/23, preoperation) to 8.70% (2/23, post-operation, χ 2 =6.86, P=0.008). Conclusions: Hysteroscopic resection of uterine septum is safe and effective. For patients with complete uterine septum, hysteroscopic resection of septum combined with laparoscopy can increase the full-term live birth rate, decrease spontaneous abortion rate, and improve patients' reproductive prognosis. [ABSTRACT FROM AUTHOR]

Recently, with the popularity of intrauterine operation, the incidence of intrauterine adhesions (IUA) is increasing gradually. Hysteroscopic adhesiolysis has become an effective treatment of IUA. Estrogen use as an perioperative adjuvant therapy has been extensively applied to clinical practice, however the treatment remains empirically based. The purpose of this article was to review the literature to understand changes of endometrium with intrauterine adhesions and to analyze the mechanism and efficacy of estrogen therapy. Furthermore, this article summarized the dose, duration and other treatment strategies of estrogen, which provide evidence to use estrogen as perioperative adjuvant therapy in IUA. [ABSTRACT FROM AUTHOR]

The incidence of female infertility is increasing year by year. Uterine cavity disease and fallopian tube lesion are two main factors of female infertility. The normal uterine cavity is the basic condition of successful pregnancy in both natural conception and assisted reproductive technology. However, a considerable number of doctors pay more attention to the examination and treatment of tubal patency, and not enough attention to the uterine cavity factors causing infertility, in their clinical diagnosis and treatment of infertility. The common uterine diseases causing infertility include endometrial polyps, intrauterine adhesion, uterine abnormalities, uterine fibroids, and so on. At home and abroad, the etiology of uterine diseases are basically similar, the different is the main cause of the order. Hysteroscopy, as a new and minimally invasive gynecological diagnosis and treatment technology, can be used to observe intuitively the uterine cavity, to understand whether there is a uterine cavity disease related to infertility, and to treat synchronously the abnormalities of uterine cavity. Hysteroscopy has become one of the preferred methods for examination and treatment of infertility. [ABSTRACT FROM AUTHOR]

About 10% to 15% of infertile women are related to the uterine cavity abnormalities. The common uterine cavity lesions include endometrial polyps, submucous fibroids, uterine septum and intrauterine adhesions. Other lesions are often found including chronic endometritis, tuberculosis, retained products of conception, and so on. These lesions may result incavity morphological abnormalities, dysfunctional uterine contractility, abnormal uterine vascularization, chronic endometrial inflammation, and the impaired endometrial receptivity, which affect the fertilization, implantation and pregnancy maintenance. Diagnostic and operative hysteroscopy can significantly improve the outcomes of clinical pregnancy in those women with uterine cavity abnormalities and unexplained infertility. [ABSTRACT FROM AUTHOR]

Objective: To explore the impact of pelvic adhesion on the fallopian tube recanalisation and the pregnancy outcomes of proximal and distal tubal surgery. Methods: The clinical data were collected from 1 038 patients who received hysteroscopic/laparoscopic examination and treatment in our hospital due to infertility. Those patients were divided into two groups according to the degree and scope of pelvic adhesion, the pelvic adhesion group included 738 cases and the control group included 300 cases without pelvic adhesion. The rates of proximal salpingemphraxis and distal fallopian tube recanalisation, and pregnancy outcomes, were analysed. Results:The incidence of distal tubal atresia in the pelvic adhesion group was higher than that in the control group (42.3% vs. 14.5%, P=0.000, OR=4.32, 95%CI:3.02-6.17). There was no significant difference in the rate of proximal obstruction between the two groups (P＞0.05). However, the rate of proximal tubal recanalisation in the pelvic adhesion group was lower than that in the control group (59.3% vs. 75.5%, P=0.005, OR=0.47, 95%CI: 0.28-0.80). There was no significant difference in the rate of distal tubal recanalisation between the two groups (84.2% vs. 86.0%, P＞0.05). The intrauterine pregnancy rate was lower in the pelvic adhesions group than that in the control group (22.6% vs. 39.6%, P＜0.001, OR=0.444, 95%CI: 0.282-0.698), while the incidence of postoperative ectopic pregnancy was higher in the pelvic adhesions group (7.2% vs. 2.7%, P=0.02), especially in patients with degree III adhesions (12.0% vs. 2.7%, P=0.01, OR=4.62, 95%CI: 1.29-16.50). The incidence of pelvic adhesions was lower in patients who got intrauterine pregnant after distal tube occlusion only and proximal combined with distal surgery than that in patients who did not get pregnant (94.9% vs. 82.1%, 91.8% vs. 67.3%, P＜0.05). Conclusions: Pelvic adhesions reduce the rate of proximal tubal recanalisation, and the rate of intrauterine pregnancy in postoperative patients with distal salpingemphraxis. Pelvic adhesions also increase the long-term risk of ectopic pregnancy in those postoperative patients. [ABSTRACT FROM AUTHOR]

Intrauterine lesions is a common gynecological and frequently -occurring disease which always with the complication of abnormal uterine bleeding clinically, and its cause complexly and pathology difficultly to decide. The early identification of benign and malignant lesions of the uterine cavity is essential to improve patients' survival and prognosis. In recent years, with the rapid development of hysteroscopy technology, it not only can bring more intuitive and accurate diagnostic methods for the detection of benign and malignant lesions, but plays an important role in the cure for intra-cavitary uterine diseases. Especially for women who wish to preserve fertility, the hysteroscopic resection can avoid unnecessary hysterectomy and preserve reproductive function of patients' which important significance for clinical and social. [ABSTRACT FROM AUTHOR]

Objective .To analyze retrospectively the hysteroscopic and morphological characteristics of endometrial polypoid (EP) lesion in infertile patients, so as to improve the diagnostic coincidence rate of hysteroscopy and histopathology. Methods : Those infertile patients performed hysteroscopy were analyzed retrospectively from February 2005 through July 2014. Hysteroscopic characteristics were then compared with histopathologic characteristics in those patients with EP. Results : 17.4% (1 372/7 884) of infertile patients were diagnosed with EP lesion by hysteroscopy. The morphological manifestation of EP lesion under hysteroscopy were as follows: endometrial neoplasm (88.0%, 1 207/1 372), endometrial local uplift (6.7%, 92/1 372), and endometrial coarse and fragment (5.3%, 73/1 372). The three most prevalent diagnoses by histopathology were endometrial polyp (83.0%, 1 139/1 372), endometrial polypoid hyperplasia (9.3%, 128/1 372) and hysteromyoma (2.2%, 31/1 372). The diagnostic coincidence rate in those patients with typical polypoid neoplasm under hysteroscopy was significantly higher than that in those patients without typical lesion (P " 0 . 0 5) . Multiple polypoid neoplasm accounted for 77.8% (1 068/1 372) of endometrial polypoid lesion diagnosed by hysteroscopy, while the coincidence rate in those patients was 98,0% (1 047/1 068), Conclusions: The diagnostic coincidence rate of hysteroscopy and histopathology is high in those patients with typical endometrial neoplasm under hysteroscopy. The hysteroscopy combined with histopathology is the golden standard for the diagnosis of endometrial lesion. [ABSTRACT FROM AUTHOR]

Endometrial polyps (EP) is one of the most common endometrial diseases. It is a common cause of menorrhagia, irregular menstrual cycle and infertility in premenopause, and associated with postmenopausal bleeding. So diagnosing EP correctly and then carrying out appropriate treatment has been the key to alleviate or remove patients' symptoms. By now, transvaginal sonography is the first clinical method for diagnosing the disease. With the wide use of hysteroscopy, the level of diagnostic EP has been significantly improved, but still refer to the pathological examination. As for the treatment of EP, there has not yet formend a clear clinical guildlines. This article will review the progress in diagnosis and treatment on EP. [ABSTRACT FROM AUTHOR]

Objective：To discuss the valuable of vaginoscopy in clinical application about pediatric vaginal drainage and bleeding. Methods：From December 2013 to March 2015 there were 42 cases of pediatric vaginal drainage and bleeding checked and treated by vaginal endoscopy. Results：21 cases vaginal drainage, by vaginal endoscopy, included 9 cases were found vaginal foreign body, 5 cases were normal, 3 cases have vaginal polyps, 4 cases were vaginitis. 17 cases were vaginal bleeding by vaginal endoscopy, 13 cases were found vaginal foreign body, a cases was normal (once diagnosed peripheral precocious puberty), 2 cases of vaginal vegetations (1 case in embryo sinus tumor, 1 case of mullerian duct papilloma), a case of vaginitis. And 4 cases of infant, their families demanded to check vaginal because they doubted their baby′s vaginal have foreign body, transvaginal endoscopic examination found no abnormalities. All of them corresponding symptomatic treatment, and removal of vaginal foreign body, resection polyps and vaginal vegetations, to treat vaginitis by medication. No abnormalities no processing. Conclusions：Vaginal endoscopy helps to clear diagnosis and treatment of female vagina drainage and bleeding. [ABSTRACT FROM AUTHOR]